1. Cindy Dullea, RN-BC, MBA, CHAM Chief Clinical Coach Marbella Technologies, Inc. Assistant Professor Uniformed Services University

2. Patient Focused Revenue Cycle Maximizing Efficiency Patient Flow Rules Based Scheduling Referral Management ICD-10 RAC Audits Self Service Patient Loyalty HCAHPS POS Collections Eligibility FRONT DOOR Medicare and Medicaid Changes Pre-Arrival Unit Employee Retention Electronic Orders Clinical Management Financial Clearance Insurance Verification Authorization Management Referral Management Self Scheduling The Alphabet Soup of Access Management

3. Source: Organization for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.

4. Medical Care … is the Fastest Growing CPI Category

5. Implications  Consumer Driven Healthcare  Passing Medical Inflation to Consumer  Spending Your Own $$ Curbs Excess Spending  High Deductible Insurance  Catastrophic Coverage Only  Provider Impact  Lower Utilization  Increased Bad Debt  Pricing Transparency  Patient  Confusion  Decreased Satisfaction

6. Patient Confusion  Quality  Food Tastes Good and Everyone Was So Nice  Pricing  Concerted Effort At Deception?  Trend toward Efficiency  Service  Convenient  Friendly  Easy What was the Patient Experience?

7. Current Healthcare Environment  Credit Markets Frozen  Economic Recession  17.% of All Americans Uninsured (2012)  60% of those Commercially Insured on High Deductible Plans with 10 million + Beneficiaries  Bad Debt Skyrocketing Nationally  National Debt Skyrocketing – averaging $1.311 trillion per year  Healthcare Reform – new taxes

8. Hospital Strategic Response  Develop a Strategy for Market Consolidation  Assess acquisition opportunities  Consider sale or affiliation opportunities  Evaluate asset performance and ownership requirements  Evaluate physician network strategies and ACO Adoption  Manage the Balance Sheet  Deploy cash judiciously  Manage relationships with financial entities  Restructure long-term debt  Monitor balance sheet closely  Update strategic capital plan  Strengthen Operating Performance  Improve throughput to increase capacity and revenue  Fine tune growth strategies  Rationalize programs and operations

9. Access Management Ordering, Scheduling, Registration Processes Key to Success Enable a ‘Smart’ Start to the Revenue Cycle Care Delivery Processes Billing Processes Enable a Great ‘Front Door’ Experience ConsumersPhysicians Utilize Resources Accurately and Optimally

10. Good Access Management Helps Hospitals  Improves Physician Networks  Connectivity = Better Service = MD Stickiness  Strengthens Operating Performance  Increase Utilization of Resources  Decrease Labor/Supply Costs  Reduce Bad Debt and Denial Write-offs  Improve Cash Flow  Basis for Great Customer Service  Convenience and Courtesy = Positive Patient Experience  Management Reporting  Continuous Operational Improvement  Development of Marketing Initiatives

11. Keys to Good Access Management  100% Coverage  Pre-Registration Revenue Cycle Activities  Identify Problems Early  Start in the MD Office or Patient’s Home  Utilize “Smart” Systems  Goal to Replace Labor  Understand the Nuances of Healthcare  Learn From the Past  Aggressive Data Collection and Feedback to Improve Operations  Know Your Customer’s Preferences  Self Service

12. What’s The Workflow?

13. Intelligent Scheduling Key Features  Rules Engine Ensures Accuracy  All Locations Search across Enterprise  Provider Portal  Self-Scheduling, Appointment Itinerary, and Online Order Submission  Consumer Portal  Self-Scheduling, Re-Scheduling, Appointment Details

14. What the Rules Engine Can Do… Based on the resource (or any resource detail), the task (or any task detail), and/or the patient (or any patient detail), the Rules Engine can:  Prompt a question  Insert a task  Replace a task  Delete a task  Modify the duration of a task  Delete a resource  Add a resource  Replace a resource  Place an entry on a Worklist  Update an entry on a Worklist …and, based on the answer to a question, the rules engine can do all this as well as prompt another question.

15. Question Answer Rule Expert Scheduling Knows the Rules Question Answer Rule

16. First available time/date at each location where test is performed Spreads demand across health system Multiple Locations – Service and $$ First available time/date at each location where test is performed Spreads demand across health system

17. Consumer Convenience

18. Start the Revenue Cycle Early Goal is 100% Coverage  Work Flow Mandatory  MD Office  Authorization and Referral Management  Medical Necessity Checking (Coding)  Pre-Registration as part of Scheduling Call  Smart Eligibility  Data QA  Support Financial Counseling/Self-Pays  Pricing Transparency  Automate ABNs  Screening for Govt and Charity Programs

19. View of All Arrivals Rules define when items are ‘escalated’ Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”) Work Flow Insures 100% Coverage View of All Arrivals Rules define when items are ‘escalated’ Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”)

20. Order Process Captures CPT & Authorizations

21. Real Time Insurance Verification

22. Beware!! Insurance Authorization Required

23. Identify Self-Pays Early for Financial Counseling

24. Details Allow POS Collection for Co-Pays

25. Financial Counseling During the FC Visit self-pay pricing and other payment options are discussed.

26. Printout Notice of Non-Coverage

27. Physician Stickiness  Improve Their Efficiency  On-line Ordering and Results Reporting  Fewer Disruptions  Medical Necessity Issues  Illegible Orders  Improve Their Office Efficiency  Faster Scheduling (One Call or Web)  Fewer Disruptions  No Lost Orders  Happy Patients  Convenience with No Surprises  Reminders (Appointments actual and preventative)

28. Timely Scheduling Avoids Problems

29. Eliminate Office Disruption from Illegible Orders

30. Results Reporting Attach results to the order or referral

31. MD to MD Referrals Includes PHI Information

32. View Entire Schedule by Day, Week, Month

33. Exporting appointments to Outlook can be done right from the Appointment Book with a few clicks Download to Smart Phone

34. Customer Self-Service  Convenience  Scheduling  Pre-Registration  Appointment Reminders  No Lost Orders or Schedule Delays  Patient Arriving  Check-in  Update Registration  Payment  Location Maps

35. Option to pick preferred location Scheduling Convenience

36. Option to pre-register for appointment Avoid Registration Lines

37. Links to online forms Eliminate Bad Prep Cancellations

38. Links to online forms Patient Itinerary Avoids Confusion

39. Patient Arrives – No Waiting

40. Patient Selects Appointment

42. Patient Updates Personal Data

43. Patient Signs Forms – Eliminates Paper

44. Patient Pays Co-Pay

45. Wayfinding

46. Why Not? Check In With Personal Devices

47. Labor Optimization  Centralized Call Centers  MD Referral  Patient Scheduling  Order Collection  Pre-Registration  Revenue Cycle Activities  Resource Utilization  Eliminates “Country Club” Scheduling  Automates Manual Tasks (e.g. Eligibility, Order Tracking)  Decreases “No Shows”

48. Call Center Productivity Average SpeedAbandonmentInbound CallsAppointmentsSchedulers to Answer (ASA)Rate/Day /Scheduler /Day Call Center29 seconds2%69629 Hospital #219 seconds3%38458 Hospital #397 seconds10%81559 Hospital #4n/a 76428 Hospital #530 seconds8%34365.5 Hospital #620 seconds4.4%45533 Hospital #79 seconds2.2%34404 The Key is Expert AM Systems because - Faster Training - Cheaper Labor - Multi-Task Performance - Multiple Facility Coverage - Better, Consistent Customer Service Better Patient Experience!

49. Resource Optimization Open Slots that may be overlooked Block Times Allocated On Experience Resources Only Allocated for Time Required

50. Ritz Ritz Carlton Service  Too Many Places to Call  Lack of Information Integration  Constant Replication of Information  Patient Dissatisfaction  Long Wait Times  Confusing Campus  Discourteous Employees

51. Marketing for Better Community Health  Individual Health Initiatives  Follow-ups  MD Orders Not Followed Through  Preventive Health Initiatives (Mammograms, Chronoscopes

52. Letters Partner Reminder Letters No-Show Letters Reporting / Access to Data Production Database Reports (and extracts) Operational Reports & Patient Itineraries Statistical, Management, Ad-Hoc Reporting iReports Secure FTP Email Power-User Itineraries faxed to MD offices Email Schedule Viewer Calls Partner Reminder Calls No-Show Calls

53. Leaving the “WHY” For Last A record 2.8 million Baby Boomers qualified for Medicare in 2011, rising to 4.2 million a year by 2030 51 million members of Generation X Generation Y – The New Millennials are 70 million strong -Young, Brash and Smart Gen Z - 1994 and before 2004 Highly connected – home computer obsolete No life before the advent of mass technology!

54. Access To Healthcare Next?

55. Cindy Dullea, RN, MBA, BC, CHAM cadullea@verizon.net